Evidence Update Malaria Series January 2005

Is intramuscular arteether (also known as artemotil) as effective as other antimalarial drugs in people with severe malaria?

There is insufficient research to know whether arteether is better or worse than quinine for patients with severe malaria.

Inclusion criteria Results

Studies: • Two small trials that compared arteether with Randomized and quasi-randomized controlled trials. intravenous quinine in 194 children were included. Both concealed allocation. Participants: • No difference in the number of deaths in those Adults and children with severe malaria as defined by receiving arteether and those receiving quinine was the World Health Organization. demonstrated (relative risk 0.75, 95% confidence interval 0.43 to 1.30, n=194; 2 trials). Intervention: • One small trial did not show a difference in the Intervention: intramuscular arteether (artemotil and number of neurological complications in those arteether). receiving arteether and those receiving quinine Control: other antimalarial drugs, including quinine, (relative risk 1.18, 95% confidence interval 0.31 to artemether, artesunate, and artemisinin, given 4.46, n=58). intravenously, intramuscularly, or rectally. • No difference was demonstrated for time to regain Outcomes: consciousness, parasite clearance time, or fever Primary: death; neurological complications at follow clearance time. up. Secondary: time to regain consciousness; presence of parasites at days 7 and 28; parasite clearance time; fever clearance time.

Adapted from Afolabi BB, Okoromah CN. Intramuscular arteether for treating severe malaria. The Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004391. DOI: 10.1002/14651858.CD004391.pub2.

Produced by the Effective Health Care Alliance Programme (www.liv.ac.uk/evidence), Liverpool School of Tropical Medicine, supported by the Department for International Development UK; and the Australasian Cochrane Centre. Authors’ conclusions

Implications for practice: The data are too limited to determine the effects of arteether on death, neurological complications at follow up, time to regain consciousness, parasite clearance time, presence of parasites on days 7 and 28, fever clearance time, and adverse events. Implications for research: More trials that compare arteether with other antimalarial drugs in children and adults, and that have sufficient statistical power to detect clinically significant differences in the number of deaths and other important outcomes, are needed.

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